“STUDY OF CLINICAL PROFILE AND PROGNOSTIC FACTORS IN COMATOSE PATIENTS ADMITTED IN MEDICAL WORDS, SIR T. HOSPITAL, G.M.C. BHAVNAGAR.”

Dr. Krishna K. Lakhani, Dr. Panna K. Kamdar and Dr. Bhoori Singh*

ABSTRACT

Objective: To study the clinical profile and etiology of altered consciousness. To re-emphasize the importance of Glassgow coma scale and bedside Sriraj Stroke Score for patients of possible cerebrovascular accidents. To evaluate individual clinical and other bedside parameters as independent predictors of prognosis in any case of altered consciousness. To evaluate incidence of morbidity and mortality in patients of altered consciousness. Materials and methods: The present study includes cases of non traumatic alteration is consciousness is due to various causes admitted in Government hospital during the period 1 June 2015 to 31 May 2016. 150 patients formed the study material. PATIENT POPULATION: The study was conducted on 150 patients with medical coma and altered consciousness. Criteria for selection of cases – (1) All patients, both male and females, over 12 years old who were admitted to hospital in altered state of consciousness. (2) Patients who became comatose after admission of 6 hours were also considered for inclusion. CRITERIA FOR EXCLUSION (1) To eliminate from consideration the transient unresponsiveness of syncope, patients with coma of less than 6 hourly were excluded. (2) Comatose patients with history suggestive of concussion without obvious external had injury. PATIENT POPULATION The study was conducted on 150 patients with medical coma and altered consciousness. Criteria for selection of cases – (3) All patients, both male and females, over 12 years old who were admitted to hospital in altered state of consciousness. (4) Patients who became comatose after admission of 6 hours were also considered for inclusion. CRITERIA FOR EXCLUSION (3) To eliminate from consideration the transient unresponsiveness of syncope, patients with coma of less than 6 hourly were excluded. (4) Comatose patients with history suggestive of concussion without obvious external had injury.  Results: Minority of patients of age above 50 years of age fall in poor outcome group. We observed a direct correlation between relation of mortality with low GCS scale.  Direct co relation between duration of coma and poor outcome.  There is high sensitivity of diagnosis of infarct and hemorrhage from SS Score.  Metabolic encephalopathy was the commonest cause of coma followed by vascular events.  Admission to study, absence of corneal reflexes, absent doll’s eye,absent papillary light reaction were each associated with poor outcome. CONCLUSION: we observed Metabolic encephalopathy was the commonest cause of coma followed by vascular events. Hypertension and debilities mellitus was common risk factor for vascular accident. Most patients were presented with more than one symptoms on admission. We identified that the majority of the patients were male who belonged to the age group 51-70 years. Cerebro vascular accident is not uncommon in younger age group.

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